Materiały źródłowe

• #1 The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6065587/

  Pseudobulbar affect is a disorder resulting from neurologic damage manifesting as sudden, stereotyped affective outbursts that are not reflective of internal emotion. […] This review revealed that it is common in neurodegenerative disorders but is poorly recognized, placing significant impacts on patients and their families. […] The occurrence of PBA has been reported in a multitude of neurologic illnesses including, but not limited to, ALS, PD and other movement disorders, MS, stroke, various types of dementia and other neurodegenerative disorders, traumatic brain injury, central nervous system tumors, neurogenetic syndromes, and viral cerebellitis. […] The reported prevalence of PBA varies greatly depending on the underlying neurologic illness, the methodology of the study, and the diagnostic criteria used to identify cases.

• #2 The epidemiology and pathophysiology of pseudobulbar affect and its as | DNND

  https://www.dovepress.com/the-epidemiology-and-pathophysiology-of-pseudobulbar-affect-and-its-as-peer-reviewed-fulltext-article-DNND

  Pseudobulbar affect is a disorder resulting from neurologic damage manifesting as sudden, stereotyped affective outbursts that are not reflective of internal emotion. […] A literature review was completed to examine the current understanding of the epidemiology, characterization, diagnosis, pathophysiology, and treatment of pseudobulbar affect. […] This review revealed that it is common in neurodegenerative disorders but is poorly recognized, placing significant impacts on patients and their families. […] The disorder appears to result from a disruption of the cortico-limbic-subcortical-thalamic-pontocerebellar network involved in emotional expression and regulation with resulting disruptions of neurotransmitter systems.

• #3

  https://link.springer.com/article/10.1007/s12325-011-0031-3

  Pseudobulbar affect (PBA) is a neurologic syndrome of emotional affect disinhibition, characterized by uncontrollable, exaggerated, and often inappropriate emotional outbursts, which may cause severe distress, embarrassment, and social dysfunction. However, the US prevalence of PBA remains unknown. […] Mean prevalence of PBA across all six conditions was 10.1%, 9.4%, and 37.5% with the PLACS 13, CNS-LS 21, and CNS-LS 13 thresholds, respectively. Using disease population estimates from government agencies and professional organizations, the estimated US population with PBA ranged from 1.8 to 7.1 million. […] The overall prevalence of PBA was estimated to be about 10% across these commonly associated underlying neurological conditions and appears to be under-recognized.

• #4 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  PBA has also been referred to as emotionalism, emotional lability, or pathological crying and laughing, particularly when attributed to stroke or traumatic brain injury (TBI).2,3 Although PBA has been recognized in science and medicine for more than 100 years, it remains an underrecognized and undertreated condition that can be effectively treated with pharmacological methods.4 The prevalence of PBA in the general US population is estimated to range from 0.5 to 2 million people.5 In a survey study to assess PBA prevalence, more than 900 respondents screened positive for PBA using a validated tool and reported sudden episodes of crying and/or laughter; however, as an indicator of the underrecognition of PBA, none of those respondents reported a specific diagnosis of PBA or related terminology.5 […] PBA is an underrecognized and undertreated condition that affects upwards of 2 million individuals in the United States. Treatment options include the off-label use of centrally acting drugs, such as antidepressants, and the FDA-approved drug combination of dextromethorphan and quinidine.

• #5

  https://www.geron.org/News-Events/GSA-News/Press-Room/Press-Releases/pseudobulbar-affect-an-often-overlooked-condition

  Pseudobulbar affect (PBA) is characterized by bouts of uncontrolled crying or laughing that are disproportionate or inappropriate to the social context and are not associated with depression or anxiety. […] An estimated 2 to 7 million individuals in the U.S. have PBA. Prevalence varies among populations with various neurologic disorders. For example, PBA has been estimated to occur in approximately 10 percent of patients with MS and up to 50 percent of patients with ALS. […] Although PBA is common in many neurologic conditions, it is often underrecognized and undertreated. However, health care providers are increasingly recognizing PBA as a behavioral symptom that is connected to brain health, and they are assessing for PBA as part of brain health management efforts.

• #6 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  Prevalence estimates place the number of people with PBA between 1.5 and 2 million in the United States alone, which would be less than 1% of the U.S. population even at the high end of the estimate. Some argue that the number is probably higher and that clinicians underdiagnose PBA. […] However, the prevalence estimate of 2 million is based on an online survey. Self-selected computer-savvy patients in at-risk groups evaluated their own symptoms and submitted their self-diagnoses. No doctor or clinic confirmed the data. Motivation to participate could have been influenced by the presence of symptoms, which would have skewed the results. The actual prevalence could very well be quite a bit lower than estimated.

• #7 Introduction to Pseudobulbar Affect: Setting the Stage for Recognition and Familiarity With This Challenging Disorder

  https://www.ajmc.com/view/introduction-to-pseudobulbar-affect-setting-the-stage-for-recognition-and-familiarity-with-this-challenging-disorder

  Pseudobulbar affect (PBA), despite its prevalence and distinctive symptoms, is widely underrecognized and undertreated. […] The PBA Registry Series trial was created to measure the prevalence of PBA among patients with these underlying neurological conditions. […] Pseudobulbar affect (PBA) affects approximately 2 million Americans. […] According to the PRISM trial results, approximately 46% of patients diagnosed with MS have symptoms suggestive of PBA. […] According to the PRISM trial results, roughly 53% and 38% of patients diagnosed with these conditions, respectively, have symptoms suggestive of PBA. […] It is estimated that up to 2 million Americans have PBA with some sources suggesting that up to 7 million individuals in the United States exhibit symptoms suggestive of PBA. […] PRISM was created to collect prevalence data from patients with symptoms due to common neurological disorders in a large, representative sample of the US population. […] A total of 36.7% of patients had CNS-LS scores 13 and 9.3% had CNS-LS scores 21. […] The prevalence of neurological diagnoses in patients 65 years in the PRISM trial was greatest in most categories, with the exception of ALS, MS, and TBI.

• #8 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  PBA affects about 1.5 million people in the United States; many cases are thought to go undiagnosed, so the actual number may be larger. […] Recognition of PBA is challenging since many physicians are unaware of the criteria for diagnosis. […] Unfortunately, patients and/or caregivers do not always discuss these episodes with their healthcare providers. […] Among those who do discuss these events, only 40% are given a diagnosis of PBA and less than half receive specific treatment. […] Because PBA is generally an under-recognized, improperly diagnosed, and insufficiently treated condition, the need for improvements in both diagnostic criteria and disease awareness is imperative. […] The most common diseases associated with PBA are Alzheimers disease (AD), ALS, multiple sclerosis (MS), Parkinsons disease (PD), stroke, and traumatic brain injury (TBI).

• #9 PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072232

  Pseudobulbar affect (PBA) is a neurological condition characterized by involuntary, sudden, and frequent episodes of laughing and/or crying, which can be socially disabling. […] Although PBA occurs secondary to many neurological conditions, with an estimated United States (US) prevalence of up to 2 million persons, it is thought to be under-recognized and undertreated. […] The PBA Registry Series (PRISM) was established to provide additional PBA symptom prevalence data in a large, representative US sample of patients with neurological conditions known to be associated with PBA. […] PRISM enrolled 5290 patients. More than one third of patients (n=1944; 36.7%) had a CNS-LS score 13, suggesting PBA symptoms. […] Data from PRISM, the largest clinic-based study to assess PBA symptom prevalence, showed that PBA symptoms were common among patients with diverse neurological conditions.

• #10 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  PBA has also been known by a variety of other terms, including affective lability, involuntary emotional expression disorder, or simply pathological laughing and crying. The 6 neurologic conditions most commonly associated with PBA are Alzheimers disease, amyotrophic lateral sclerosis (ALS), MS, Parkinsons disease, stroke, and traumatic brain injury (TBI). An online survey by Work et al screened 2,318 patients with these conditions for PBA, and, using disease population estimates from government agencies and professional organizations, the investigators reported a US prevalence of PBA ranging from 1.8 million to 7.1 million people, depending on the screening tools and thresholds used. The highest prevalence (a mean rate of 37.5%) was found using the Center for Neurologic Study-Lability Scale (CNS-LS) with a cutoff score of 13.

• #11 The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6065587/

  Pseudobulbar affect is a disorder resulting from neurologic damage manifesting as sudden, stereotyped affective outbursts that are not reflective of internal emotion. […] This review revealed that it is common in neurodegenerative disorders but is poorly recognized, placing significant impacts on patients and their families. […] The occurrence of PBA has been reported in a multitude of neurologic illnesses including, but not limited to, ALS, PD and other movement disorders, MS, stroke, various types of dementia and other neurodegenerative disorders, traumatic brain injury, central nervous system tumors, neurogenetic syndromes, and viral cerebellitis. […] The reported prevalence of PBA varies greatly depending on the underlying neurologic illness, the methodology of the study, and the diagnostic criteria used to identify cases.

• #12 Pseudobulbar Affect (PBA) – PsychDB

  https://www.psychdb.com/teaching/pseudobulbar-affect

  The prevalence of PBA varies greatly across different neurological conditions and depends on the case studies and series describing them. Thus, prevalence estimates are not perfectly accurate. […] Disease Prevalence Amyotrophic Lateral Sclerosis (ALS) 12 to 70% (some case series suggest half of all ALS have PBA) Parkinson’s Disease 3 to 43% Alzheimer’s Dementia 9 to 40% Multiple sclerosis 10 to 50% Stroke 5 to 60% Traumatic brain injury 5 to 80% (upper range is an overestimate) Parkinson’s Disease 3 to 43%

• #13 Pseudobulbar Affect

  https://www.bcm.edu/healthcare/specialties/neurology/neuropsychology/pseudobulbar-affect

  Pseudobulbar affect (PBA) is involuntary and uncontrollable episodes of either laughing or crying that seem inappropriate in the social situation. […] Between 43 and 49 percent of individuals with ALS exhibit PBA. PBA is also found in individuals with stroke, traumatic brain injury, multiple sclerosis, Parkinson’s disease, and Alzheimer’s disease.

• #14 Pseudobulbar Affect (PBA) – PsychDB

  https://www.psychdb.com/teaching/pseudobulbar-affect

  The prevalence of PBA varies greatly across different neurological conditions and depends on the case studies and series describing them. Thus, prevalence estimates are not perfectly accurate. […] Disease Prevalence Amyotrophic Lateral Sclerosis (ALS) 12 to 70% (some case series suggest half of all ALS have PBA) Parkinson’s Disease 3 to 43% Alzheimer’s Dementia 9 to 40% Multiple sclerosis 10 to 50% Stroke 5 to 60% Traumatic brain injury 5 to 80% (upper range is an overestimate) Parkinson’s Disease 3 to 43%

• #15 Pseudobulbar Affect in Parkinsonian Disorders: A Review

  https://www.e-jmd.org/journal/view.php?doi=10.14802/jmd.18051

  Pseudobulbar affect (PBA) is a neurological symptom of inappropriate and uncontrollable laughter or crying that occurs secondary to a variety of neurological conditions, including parkinsonian disorders. PBA is a socially and emotionally debilitating symptom that has been estimated to affect 3.6% to 42.5% of the population with Parkinson’s disease. […] Estimates of the prevalence of PBA symptoms vary considerably across different neurological conditions and are dependent upon scales used to assess symptoms and the cutoff thresholds selected. In one study, the prevalence of PBA in a group of patients with AD, ALS, MS, stroke, TBI and PD ranged from 9.4% to 37.5% depending upon the scale and the threshold used. […] PBA prevalence rates in patients with PD have been shown to range from 3.6% to 43%, and this high variability is in part secondary to differences in indexing measures and thresholds used. […] This variability speaks to the need for a standardized and cross-culturally validated method of assessing PBA in patients with parkinsonian disorders.

• #16 Pseudobulbar Affect in Patients with Multiple Sclerosis: A Systematic Review

  https://www.mdpi.com/2813-3064/2/3/13

  Pseudobulbar affect (PBA), also referred to as pathological laughing and crying, is an under-recognized and under-treated co-morbidity. […] The prevalence of PBA in the context of MS was found to range between 2% and 10% (median 10%), with higher percentages in the female population. […] From an epidemiological perspective, affective disorders are the most common psychiatric co-morbidity in MS, reported by the majority of patients. […] PBA has been reported in the context of MS, as well as in association with neurodegenerative conditions and focal brain pathologies. […] Little is known about the exact prevalence of PBA in patients with MS, with reported figures showing a wide variability. […] Despite its impact on the lives of both patients and their caregivers, PBA is often underdiagnosed, partially because it can be easily confused with other psychiatric and neurological conditions.

• #17 Pseudobulbar Affect in Patients with Multiple Sclerosis: A Systematic Review

  https://www.mdpi.com/2813-3064/2/3/13

  The differential diagnosis between PBA and other affective disorders, such as depression or mania, is often challenging. […] We set out to conduct a systematic literature review in order to determine the prevalence and clinical characteristics of PBA in patients with MS across the lifespan. […] The prevalence of PBA in patients with MS was estimated in eight studies that used different assessment methods and cut-offs, resulting in a wide range of figures, from 2% to 47%. […] The observed correlation between PBA and the female sex suggests a greater susceptibility of women with MS to the development of this pathological condition. […] The reviewed literature also highlighted a correlation between PBA and affective symptoms or a formal diagnosis of depression. […] Our review confirmed the existence of conflicting results about the relationship between PBA and MS course: both the relapsing–remitting course and the chronic progressive course have been reported to be selectively associated with the development of PBA.

• #18

  https://www.geron.org/News-Events/GSA-News/Press-Room/Press-Releases/pseudobulbar-affect-an-often-overlooked-condition

  Pseudobulbar affect (PBA) is characterized by bouts of uncontrolled crying or laughing that are disproportionate or inappropriate to the social context and are not associated with depression or anxiety. […] An estimated 2 to 7 million individuals in the U.S. have PBA. Prevalence varies among populations with various neurologic disorders. For example, PBA has been estimated to occur in approximately 10 percent of patients with MS and up to 50 percent of patients with ALS. […] Although PBA is common in many neurologic conditions, it is often underrecognized and undertreated. However, health care providers are increasingly recognizing PBA as a behavioral symptom that is connected to brain health, and they are assessing for PBA as part of brain health management efforts.

• #19 Pseudobulbar Affect (PBA) – PsychDB

  https://www.psychdb.com/teaching/pseudobulbar-affect

  The prevalence of PBA varies greatly across different neurological conditions and depends on the case studies and series describing them. Thus, prevalence estimates are not perfectly accurate. […] Disease Prevalence Amyotrophic Lateral Sclerosis (ALS) 12 to 70% (some case series suggest half of all ALS have PBA) Parkinson’s Disease 3 to 43% Alzheimer’s Dementia 9 to 40% Multiple sclerosis 10 to 50% Stroke 5 to 60% Traumatic brain injury 5 to 80% (upper range is an overestimate) Parkinson’s Disease 3 to 43%

• #20 Pseudobulbar Affect: Expert Insights

  https://www.medscape.org/viewarticle/782593_3

  There are many causes of PBA, including Alzheimer disease, amyotrophic lateral sclerosis (ALS), brain tumors, frontotemporal dementia (FTD), multiple sclerosis (MS), neurosyphilis, normal pressure hydrocephalus (NPH), Parkinson disease (PD), progressive supranuclear palsy (PSP), stroke, traumatic brain injury (TBI), vascular dementia, and Wilson disease. […] The prevalence of PBA differs according to the underlying etiology. In a study by Strowd et al, 7% of patients with a wide range of movement disorders evidenced PBA. […] A study of a consecutive series of 103 patients with Alzheimer disease noted that 39% had pathologic affect, 25% had crying episodes, and 14% showed laughing or mixed laughing and crying episodes. […] Estimates of the prevalence of PBA in MS suggest that it is observable in 10% of patients. It may be present in as many as 50% of patients with ALS.

• #21 Pseudobulbar Affect (PBA) – PsychDB

  https://www.psychdb.com/teaching/pseudobulbar-affect

  The prevalence of PBA varies greatly across different neurological conditions and depends on the case studies and series describing them. Thus, prevalence estimates are not perfectly accurate. […] Disease Prevalence Amyotrophic Lateral Sclerosis (ALS) 12 to 70% (some case series suggest half of all ALS have PBA) Parkinson’s Disease 3 to 43% Alzheimer’s Dementia 9 to 40% Multiple sclerosis 10 to 50% Stroke 5 to 60% Traumatic brain injury 5 to 80% (upper range is an overestimate) Parkinson’s Disease 3 to 43%

• #22 What Is Pseudobulbar Affect? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/pseudobulbar-affect/

  Pseudobulbar affect is probably underrecognized by clinicians and patients, says Maragakis. […] A nationwide survey targeted six neurological disorders in which PBA can develop ALS, MS, Alzheimers disease, stroke, Parkinsons disease, and traumatic brain injury to determine the number of people with PBA. Estimates range from 1.8 to 7.1 million in the United States, depending on the diagnostic test used and the scoring scale. […] A meta-analysis that looked just at the prevalence of pseudobulbar affect in people who had had a stroke concluded that PBA affects approximately 1 in 5 stroke survivors soon after the stroke, and 1 in 8 survivors beyond six months after the stroke.

• #23 Pseudobulbar Affect (PBA) – PsychDB

  https://www.psychdb.com/teaching/pseudobulbar-affect

  The prevalence of PBA varies greatly across different neurological conditions and depends on the case studies and series describing them. Thus, prevalence estimates are not perfectly accurate. […] Disease Prevalence Amyotrophic Lateral Sclerosis (ALS) 12 to 70% (some case series suggest half of all ALS have PBA) Parkinson’s Disease 3 to 43% Alzheimer’s Dementia 9 to 40% Multiple sclerosis 10 to 50% Stroke 5 to 60% Traumatic brain injury 5 to 80% (upper range is an overestimate) Parkinson’s Disease 3 to 43%

• #24 (PDF) The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration

  https://www.academia.edu/36881214/The_epidemiology_and_pathophysiology_of_pseudobulbar_affect_and_its_association_with_neurodegeneration

  Pseudobulbar affect is a disorder resulting from neurologic damage manifesting as sudden, stereotyped affective outbursts that are not reflective of internal emotion. […] This review revealed that it is common in neurodegenerative disorders but is poorly recognized, placing significant impacts on patients and their families. […] The reported prevalence of PBA varies greatly depending on the underlying neurologic illness, the methodology of the study, and the diagnostic criteria used to identify cases. […] Epidemiology studies show that 5.3%-48.2% of people with traumatic brain injury (TBI) may have symptoms consistent with (or suggestive of) PBA. […] PBA is a term used for an emotional disinhibition syndrome characterized by sudden and involuntary episodes of crying or laughing which are not in proportion to the stimulus applied or occur without stimulus. The condition can be present in patients with various neurological disorders, such as amyotrophic lateral sclerosis, Alzheimer#39;s disease, Parkinson#39;s disease, patients having recovered from stroke, or following traumatic brain injury. The estimated prevalence in patients with MS ranges from 10% to 46.2%. […] Pseudobulbar affect (PBA) is a dysfunction of emotional expression characterized by involuntary outbursts of crying or laughing disproportionate or unrelated to mood, occurring in patients with various underlying neurologic disorders.

• #25 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  In a registry study called PRISM, Brooks and colleagues evaluated the prevalence of PBA by enrolling patients with these 6 neurologic diseases at 173 sites. Data from 5,290 patients showed an overall prevalence rate of 37%, ranging from 26% in Parkinsons disease to 52% in TBI. […] Due to the potential for an increasing incidence of neurologic conditions such as Alzheimers disease among the aging population, health care professionals may begin to encounter more patients with PBA. In the PRISM study, 58% of participants were aged 65 years and older, and in this subgroup the overall prevalence of PBA was 27%. […] Unfortunately, PBA has often been missed by clinicians. The survey by Work and colleagues indicated that, among patients who discussed their crying/laughing symptoms with a physician, 41% received a diagnosis, but none received a diagnosis of PBA.

• #26 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  In a registry study called PRISM, Brooks and colleagues evaluated the prevalence of PBA by enrolling patients with these 6 neurologic diseases at 173 sites. Data from 5,290 patients showed an overall prevalence rate of 37%, ranging from 26% in Parkinsons disease to 52% in TBI. […] Due to the potential for an increasing incidence of neurologic conditions such as Alzheimers disease among the aging population, health care professionals may begin to encounter more patients with PBA. In the PRISM study, 58% of participants were aged 65 years and older, and in this subgroup the overall prevalence of PBA was 27%. […] Unfortunately, PBA has often been missed by clinicians. The survey by Work and colleagues indicated that, among patients who discussed their crying/laughing symptoms with a physician, 41% received a diagnosis, but none received a diagnosis of PBA.

• #27 Pseudobulbar Affect in Patients with Multiple Sclerosis: A Systematic Review

  https://www.mdpi.com/2813-3064/2/3/13

  The differential diagnosis between PBA and other affective disorders, such as depression or mania, is often challenging. […] We set out to conduct a systematic literature review in order to determine the prevalence and clinical characteristics of PBA in patients with MS across the lifespan. […] The prevalence of PBA in patients with MS was estimated in eight studies that used different assessment methods and cut-offs, resulting in a wide range of figures, from 2% to 47%. […] The observed correlation between PBA and the female sex suggests a greater susceptibility of women with MS to the development of this pathological condition. […] The reviewed literature also highlighted a correlation between PBA and affective symptoms or a formal diagnosis of depression. […] Our review confirmed the existence of conflicting results about the relationship between PBA and MS course: both the relapsing–remitting course and the chronic progressive course have been reported to be selectively associated with the development of PBA.

• #28 Pseudobulbar Affect in Patients with Multiple Sclerosis: A Systematic Review

  https://www.mdpi.com/2813-3064/2/3/13

  The differential diagnosis between PBA and other affective disorders, such as depression or mania, is often challenging. […] We set out to conduct a systematic literature review in order to determine the prevalence and clinical characteristics of PBA in patients with MS across the lifespan. […] The prevalence of PBA in patients with MS was estimated in eight studies that used different assessment methods and cut-offs, resulting in a wide range of figures, from 2% to 47%. […] The observed correlation between PBA and the female sex suggests a greater susceptibility of women with MS to the development of this pathological condition. […] The reviewed literature also highlighted a correlation between PBA and affective symptoms or a formal diagnosis of depression. […] Our review confirmed the existence of conflicting results about the relationship between PBA and MS course: both the relapsing–remitting course and the chronic progressive course have been reported to be selectively associated with the development of PBA.

• #29 The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6065587/

  The limitations of studies to date include the lack of consensus on diagnostic criteria and terminology, small sample sizes, varied populations presenting with PBA, inconsistent methods used between studies for finding cases, measuring symptoms and response, lack of assessment of comorbidity, lack of long-term data, and lack of comparative studies between the various available pharmacologic agents.

• #30 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  PBA has also been referred to as emotionalism, emotional lability, or pathological crying and laughing, particularly when attributed to stroke or traumatic brain injury (TBI).2,3 Although PBA has been recognized in science and medicine for more than 100 years, it remains an underrecognized and undertreated condition that can be effectively treated with pharmacological methods.4 The prevalence of PBA in the general US population is estimated to range from 0.5 to 2 million people.5 In a survey study to assess PBA prevalence, more than 900 respondents screened positive for PBA using a validated tool and reported sudden episodes of crying and/or laughter; however, as an indicator of the underrecognition of PBA, none of those respondents reported a specific diagnosis of PBA or related terminology.5 […] PBA is an underrecognized and undertreated condition that affects upwards of 2 million individuals in the United States. Treatment options include the off-label use of centrally acting drugs, such as antidepressants, and the FDA-approved drug combination of dextromethorphan and quinidine.

• #31

• #32 Pseudobulbar affect: Symptoms, tests, and treatment

  https://www.medicalnewstoday.com/articles/pseudobulbar-affect

  Pseudobulbar affect (PBA) involves brief, uncontrolled episodes of crying or laughing. It can result from various neurological conditions, such as stroke or multiple sclerosis (MS). […] The estimated prevalence of PBA among people with neurological disorders in the United States ranges from 9.4% to 37.5%. This means that between 1.8 and 7.1 million Americans experience PBA. […] A 2020 analysis of stroke survivors and caregivers found that many of the doctors they interacted with during diagnosis and treatment had a low awareness of what PBA is. […] Clinicians often diagnose PBA informally as part of a neurological evaluation. […] The goal of treatment for PBA is to decrease the frequency and severity of episodes to improve quality of life. […] PBA is not a condition in its own right, so the outlook depends on what is causing it.

• #33 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  In a registry study called PRISM, Brooks and colleagues evaluated the prevalence of PBA by enrolling patients with these 6 neurologic diseases at 173 sites. Data from 5,290 patients showed an overall prevalence rate of 37%, ranging from 26% in Parkinsons disease to 52% in TBI. […] Due to the potential for an increasing incidence of neurologic conditions such as Alzheimers disease among the aging population, health care professionals may begin to encounter more patients with PBA. In the PRISM study, 58% of participants were aged 65 years and older, and in this subgroup the overall prevalence of PBA was 27%. […] Unfortunately, PBA has often been missed by clinicians. The survey by Work and colleagues indicated that, among patients who discussed their crying/laughing symptoms with a physician, 41% received a diagnosis, but none received a diagnosis of PBA.

• #34 PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072232

  These data underscore a need for greater awareness, recognition, and diagnosis of PBA. […] The PRISM registry is the largest study to date to assess PBA symptom prevalence in a clinical setting across a variety of neurological conditions. […] Taken together, the data from the registry, the online survey, and existing prevalence literature present increasingly consistent evidence that PBA symptoms are common in patients with diverse neurological diseases. […] The PRISM registry is currently the largest clinic-based study to assess PBA symptoms among neurological disorders known to be associated with PBA.

• #35 The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6065587/

  Estimates of prevalence for specific diseases from this study and other studies indicate that true prevalence in neurodegenerative disorders may range from 2%60% in ALS, 5%17% in PD, 7%29% in MS, and 10%74% in Alzheimers dementia. […] Quality of life is significantly affected by PBA with apparent detrimental effects on rehabilitation, occupational functioning, social functioning, and quality of relationships. […] PBA was the main reason for becoming housebound for 24% of respondents, and produced significant caregiver burden. […] The pathophysiology of PBA is likely varied and best conceptualized as a focal or diffuse disruption in the complex neurocircuitry or neurochemistry involved in the inhibition of emotional expression. […] PBA is theorized to come from a disruption in a complex cortico-limbic-subcortico-thalamic-pontocerebellar network, which is often related to lesions in descending corticobulbar fibers that inhibit emotional motor networks, lesions in brainstem and cerebellum white matter pathways that modulate emotion expression, and multiple abnormalities in neurotransmitter function.

• #36 The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6065587/

  Estimates of prevalence for specific diseases from this study and other studies indicate that true prevalence in neurodegenerative disorders may range from 2%60% in ALS, 5%17% in PD, 7%29% in MS, and 10%74% in Alzheimers dementia. […] Quality of life is significantly affected by PBA with apparent detrimental effects on rehabilitation, occupational functioning, social functioning, and quality of relationships. […] PBA was the main reason for becoming housebound for 24% of respondents, and produced significant caregiver burden. […] The pathophysiology of PBA is likely varied and best conceptualized as a focal or diffuse disruption in the complex neurocircuitry or neurochemistry involved in the inhibition of emotional expression. […] PBA is theorized to come from a disruption in a complex cortico-limbic-subcortico-thalamic-pontocerebellar network, which is often related to lesions in descending corticobulbar fibers that inhibit emotional motor networks, lesions in brainstem and cerebellum white matter pathways that modulate emotion expression, and multiple abnormalities in neurotransmitter function.

• #37 The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6065587/

  Estimates of prevalence for specific diseases from this study and other studies indicate that true prevalence in neurodegenerative disorders may range from 2%60% in ALS, 5%17% in PD, 7%29% in MS, and 10%74% in Alzheimers dementia. […] Quality of life is significantly affected by PBA with apparent detrimental effects on rehabilitation, occupational functioning, social functioning, and quality of relationships. […] PBA was the main reason for becoming housebound for 24% of respondents, and produced significant caregiver burden. […] The pathophysiology of PBA is likely varied and best conceptualized as a focal or diffuse disruption in the complex neurocircuitry or neurochemistry involved in the inhibition of emotional expression. […] PBA is theorized to come from a disruption in a complex cortico-limbic-subcortico-thalamic-pontocerebellar network, which is often related to lesions in descending corticobulbar fibers that inhibit emotional motor networks, lesions in brainstem and cerebellum white matter pathways that modulate emotion expression, and multiple abnormalities in neurotransmitter function.

• #38

  https://link.springer.com/article/10.1007/s12325-012-0043-7

  PBA is associated with considerable burden incremental to that of the underlying neurological conditions, affecting QOL, QOR, health status, and social and occupational functioning. […] The impact of PBA on social and occupational function, health status, quality of life (QOL), and quality of relationships (QOR) is not well studied. […] PBA was identified by a Center for Neurologic Study lability scale score of 13 or greater. […] The PBA group showed significantly worse scores versus non-PBA controls on component and summary SF-36 scores (P 0.05 for all), VAS scores (P 0.05 for both), and WPAI scores (P 0.05).

• #39 PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072232

  Pseudobulbar affect (PBA) is a neurological condition characterized by involuntary, sudden, and frequent episodes of laughing and/or crying, which can be socially disabling. […] Although PBA occurs secondary to many neurological conditions, with an estimated United States (US) prevalence of up to 2 million persons, it is thought to be under-recognized and undertreated. […] The PBA Registry Series (PRISM) was established to provide additional PBA symptom prevalence data in a large, representative US sample of patients with neurological conditions known to be associated with PBA. […] PRISM enrolled 5290 patients. More than one third of patients (n=1944; 36.7%) had a CNS-LS score 13, suggesting PBA symptoms. […] Data from PRISM, the largest clinic-based study to assess PBA symptom prevalence, showed that PBA symptoms were common among patients with diverse neurological conditions.

• #40 PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072232

  These data underscore a need for greater awareness, recognition, and diagnosis of PBA. […] The PRISM registry is the largest study to date to assess PBA symptom prevalence in a clinical setting across a variety of neurological conditions. […] Taken together, the data from the registry, the online survey, and existing prevalence literature present increasingly consistent evidence that PBA symptoms are common in patients with diverse neurological diseases. […] The PRISM registry is currently the largest clinic-based study to assess PBA symptoms among neurological disorders known to be associated with PBA.

• #41 PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072232

  These data underscore a need for greater awareness, recognition, and diagnosis of PBA. […] The PRISM registry is the largest study to date to assess PBA symptom prevalence in a clinical setting across a variety of neurological conditions. […] Taken together, the data from the registry, the online survey, and existing prevalence literature present increasingly consistent evidence that PBA symptoms are common in patients with diverse neurological diseases. […] The PRISM registry is currently the largest clinic-based study to assess PBA symptoms among neurological disorders known to be associated with PBA.

• #42 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  Standardized rating scales can be used for PBA as screening instruments or to better objectively measure PBA. […] The goals of pharmacotherapy are to reduce both the severity and frequency of PBA episodes. […] The only FDA-approved product for PBA, Nuedexta, is a fixed-dose combination of dextromethorphan hydrobromide/quinidine sulfate (DHQ). […] In a review of the available evidence-based guidelines, two treatment guidelines are available on the management of PBA: the American Academy of Neurology guideline for Amyotrophic Lateral Sclerosis and the American Academy of Neurology guidelines for Psychiatric Disorders in Multiple Sclerosis.

• #43 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  PBA has also been known by a variety of other terms, including affective lability, involuntary emotional expression disorder, or simply pathological laughing and crying. The 6 neurologic conditions most commonly associated with PBA are Alzheimers disease, amyotrophic lateral sclerosis (ALS), MS, Parkinsons disease, stroke, and traumatic brain injury (TBI). An online survey by Work et al screened 2,318 patients with these conditions for PBA, and, using disease population estimates from government agencies and professional organizations, the investigators reported a US prevalence of PBA ranging from 1.8 million to 7.1 million people, depending on the screening tools and thresholds used. The highest prevalence (a mean rate of 37.5%) was found using the Center for Neurologic Study-Lability Scale (CNS-LS) with a cutoff score of 13.

• #44

  https://link.springer.com/article/10.1007/s12325-011-0031-3

  Pseudobulbar affect (PBA) is a neurologic syndrome of emotional affect disinhibition, characterized by uncontrollable, exaggerated, and often inappropriate emotional outbursts, which may cause severe distress, embarrassment, and social dysfunction. However, the US prevalence of PBA remains unknown. […] Mean prevalence of PBA across all six conditions was 10.1%, 9.4%, and 37.5% with the PLACS 13, CNS-LS 21, and CNS-LS 13 thresholds, respectively. Using disease population estimates from government agencies and professional organizations, the estimated US population with PBA ranged from 1.8 to 7.1 million. […] The overall prevalence of PBA was estimated to be about 10% across these commonly associated underlying neurological conditions and appears to be under-recognized.

• #45

  https://link.springer.com/article/10.1007/s12325-011-0031-3

  Pseudobulbar affect (PBA) is a neurologic syndrome of emotional affect disinhibition, characterized by uncontrollable, exaggerated, and often inappropriate emotional outbursts, which may cause severe distress, embarrassment, and social dysfunction. However, the US prevalence of PBA remains unknown. […] Mean prevalence of PBA across all six conditions was 10.1%, 9.4%, and 37.5% with the PLACS 13, CNS-LS 21, and CNS-LS 13 thresholds, respectively. Using disease population estimates from government agencies and professional organizations, the estimated US population with PBA ranged from 1.8 to 7.1 million. […] The overall prevalence of PBA was estimated to be about 10% across these commonly associated underlying neurological conditions and appears to be under-recognized.

• #46 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  In a registry study called PRISM, Brooks and colleagues evaluated the prevalence of PBA by enrolling patients with these 6 neurologic diseases at 173 sites. Data from 5,290 patients showed an overall prevalence rate of 37%, ranging from 26% in Parkinsons disease to 52% in TBI. […] Due to the potential for an increasing incidence of neurologic conditions such as Alzheimers disease among the aging population, health care professionals may begin to encounter more patients with PBA. In the PRISM study, 58% of participants were aged 65 years and older, and in this subgroup the overall prevalence of PBA was 27%. […] Unfortunately, PBA has often been missed by clinicians. The survey by Work and colleagues indicated that, among patients who discussed their crying/laughing symptoms with a physician, 41% received a diagnosis, but none received a diagnosis of PBA.

• #47 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  In a registry study called PRISM, Brooks and colleagues evaluated the prevalence of PBA by enrolling patients with these 6 neurologic diseases at 173 sites. Data from 5,290 patients showed an overall prevalence rate of 37%, ranging from 26% in Parkinsons disease to 52% in TBI. […] Due to the potential for an increasing incidence of neurologic conditions such as Alzheimers disease among the aging population, health care professionals may begin to encounter more patients with PBA. In the PRISM study, 58% of participants were aged 65 years and older, and in this subgroup the overall prevalence of PBA was 27%. […] Unfortunately, PBA has often been missed by clinicians. The survey by Work and colleagues indicated that, among patients who discussed their crying/laughing symptoms with a physician, 41% received a diagnosis, but none received a diagnosis of PBA.

• #48 Diagnosis and Treatment of Pseudobulbar Affect

  https://www.todaysgeriatricmedicine.com/archive/MA16p30.shtml

  Pseudobulbar affect (PBA) is a distressing neurologic condition that occurs secondary to brain injury or underlying neurologic disease affecting the brain. A recent study found that 9% of nursing home residents had symptoms suggestive of PBA and were receiving more psychiatric medications than those without symptoms. […] It is estimated that more than 2 million Americans may suffer from PBA. […] Results of the study, published in the International Journal of Geriatric Psychiatry in November 2015, found that more than one-half of the nursing home residents (412 or 51%) had a predisposing neurologic condition known to be associated with PBA (eg, PD, AD, stroke, TBI, MS, or ALS). […] This finding translated to a potential prevalence of PBA of 17.5% in the predisposed population (those with neurologic disorders and without psychosis or disruptive behavior) and 9% among all nursing home residents.

• #49 Pseudobulbar affect: prevalence and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3849173/

  Pseudobulbar affect (PBA) may occur in association with a variety of neurological diseases, and so may be encountered in the setting of amyotrophic lateral sclerosis, extrapyramidal and cerebellar disorders, multiple sclerosis, traumatic brain injury, Alzheimers disease, stroke, and brain tumors. […] The range of estimates of prevalence in various neurological disorders is high, ranging from 5% to well over 50%, depending on diagnostic criteria, methodologies, and patient populations studied. […] A recent novel attempt to estimate the prevalence of PBA in the USA across six neurological disorders utilized an online survey of patients with ALS, MS, Alzheimers disease, stroke, Parkinsons disease, and traumatic brain injury. […] Even if the lower estimate is accepted as being the most accurate, this means that PBA is a significant national health issue in the USA, occurring in greater numbers of individuals than those affected by Parkinsons disease, MS, or ALS.

• #50 Pseudobulbar affect: prevalence and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3849173/

  Pseudobulbar affect (PBA) may occur in association with a variety of neurological diseases, and so may be encountered in the setting of amyotrophic lateral sclerosis, extrapyramidal and cerebellar disorders, multiple sclerosis, traumatic brain injury, Alzheimers disease, stroke, and brain tumors. […] The range of estimates of prevalence in various neurological disorders is high, ranging from 5% to well over 50%, depending on diagnostic criteria, methodologies, and patient populations studied. […] A recent novel attempt to estimate the prevalence of PBA in the USA across six neurological disorders utilized an online survey of patients with ALS, MS, Alzheimers disease, stroke, Parkinsons disease, and traumatic brain injury. […] Even if the lower estimate is accepted as being the most accurate, this means that PBA is a significant national health issue in the USA, occurring in greater numbers of individuals than those affected by Parkinsons disease, MS, or ALS.

• #51 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  In a registry study called PRISM, Brooks and colleagues evaluated the prevalence of PBA by enrolling patients with these 6 neurologic diseases at 173 sites. Data from 5,290 patients showed an overall prevalence rate of 37%, ranging from 26% in Parkinsons disease to 52% in TBI. […] Due to the potential for an increasing incidence of neurologic conditions such as Alzheimers disease among the aging population, health care professionals may begin to encounter more patients with PBA. In the PRISM study, 58% of participants were aged 65 years and older, and in this subgroup the overall prevalence of PBA was 27%. […] Unfortunately, PBA has often been missed by clinicians. The survey by Work and colleagues indicated that, among patients who discussed their crying/laughing symptoms with a physician, 41% received a diagnosis, but none received a diagnosis of PBA.

• #52 Diagnosis and Treatment of Pseudobulbar Affect

  https://www.todaysgeriatricmedicine.com/archive/MA16p30.shtml

  Identifying and managing PBA can be challenging for clinicians because it is underrecognized and the symptoms overlap with those of depression and other psychiatric disorders. […] As the first study to investigate the prevalence of PBA symptoms in nursing home residents and evaluate real-world treatment patterns, the results suggest that off-label medications are potentially being used to treat PBA in nursing home residents.

• #53 ALS – Wikipedia

  https://en.wikipedia.org/wiki/ALS

  About 80% of ALS epidemiology studies have been conducted in Europe and the United States, mostly in people of northern European descent. […] There are several geographic clusters in the Western Pacific where the prevalence of ALS was reported to be 50-100 times higher than in the rest of the world, including Guam, the Kii Peninsula of Japan, and Western New Guinea. The incidence in these areas has decreased since the 1960s; the cause remains unknown.

• #54 The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6065587/

  Pseudobulbar affect is a disorder resulting from neurologic damage manifesting as sudden, stereotyped affective outbursts that are not reflective of internal emotion. […] This review revealed that it is common in neurodegenerative disorders but is poorly recognized, placing significant impacts on patients and their families. […] The occurrence of PBA has been reported in a multitude of neurologic illnesses including, but not limited to, ALS, PD and other movement disorders, MS, stroke, various types of dementia and other neurodegenerative disorders, traumatic brain injury, central nervous system tumors, neurogenetic syndromes, and viral cerebellitis. […] The reported prevalence of PBA varies greatly depending on the underlying neurologic illness, the methodology of the study, and the diagnostic criteria used to identify cases.

• #55 PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072232

  These data underscore a need for greater awareness, recognition, and diagnosis of PBA. […] The PRISM registry is the largest study to date to assess PBA symptom prevalence in a clinical setting across a variety of neurological conditions. […] Taken together, the data from the registry, the online survey, and existing prevalence literature present increasingly consistent evidence that PBA symptoms are common in patients with diverse neurological diseases. […] The PRISM registry is currently the largest clinic-based study to assess PBA symptoms among neurological disorders known to be associated with PBA.

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